An observation made by many in South Africa’s health industry is that a national health insurance (NHI) scheme will fail if the country’s public hospitals continue to function as badly as they currently do. Mismanagement and poor services are the norm at many of South Africa’s government medical facilities. Industry insiders said the country’s beleaguered public health system will have to be improved drastically for the NHI to be properly implemented.
‘We have public health expenditure with bad outcomes,” said Alex van den Heever of Wits University’s School of Public and Development Management. ‘Raising more money for healthcare through the NHI doesn’t guarantee that health outcomes will improve. The real problem is the administration of that service.”
The present ‘lack of accountability” for the mismanagement of state medical facilities is a ‘huge problem”, said Roly Buys of the Medi-clinic hospital group.
He said that South Africa should follow international practice and allow independent boards, instead of government, to run public hospitals. ‘All over the world hospital trusts are being created with a board of directors that consists of members of the public. The board holds the hospital accountable for its services. It makes a huge difference in the efficiency of hospitals,” said Buys.
Health Minister Aaron Motsoaledi said he was committed to addressing mismanagement in state health facilities. He’s creating an ‘office of standards compliance”, which will include an inspectorate, an ombudsman and ‘early warning systems”. The office will be a regulator with legal status, similar to the Health Professions Council, and will report to the minister.
But Van den Heever said that Motsoaledi’s responsibility for such a regulatory body should extend only to approving its creation and that it should be ‘100% independent of government”.
He said: ‘The minister should not be able to intervene with the office on any level, because, potentially, he could protect people — it’s a conflict of interest. The office won’t have any impact if it becomes politically compromised.”
Motsoaledi responded that, as he was ultimately responsible for quality healthcare in the country, he needed to ‘liaise” with the regulator. ‘The office of standards compliance has to set standards for healthcare. If I have no link to such an office, how can I ensure that sufficient standards apply?” he asked. ‘The question people should rather ask is: To what extent should the minister be involved?”
Another problem highlighted by sources in the health sector is the ‘lack of autonomy” state hospital chiefs have, especially with regard to managing staff and supplies. Jonathan Broomberg of Discovery Health said the heads of large state hospitals, such as Chris Hani Baragwanath in Soweto, had ‘little authority to make real decisions over critical management issues”. Because of this, he said, government health institutions were not being run efficiently.
‘[State] hospital chief executives have little say in the hiring and firing of staff or the purchasing of new equipment. There is also no real incentive to collect money from patients who can pay as the money goes back to the Gauteng government and not to the hospital itself,” he said.
State hospital chiefs are not permitted to contract companies directly to repair broken medical equipment as different government departments are responsible for different parts of a hospital.
‘If the geyser of a government hospital breaks, the chief executive can’t have it fixed as the hospital is owned by the department of public works and not the health department. The hospital therefore has to wait for that department’s people to arrive. It’s a complex process, over which the hospital has very little control, so the geyser could end up being broken for weeks,” said Graham Anderson of Profmed medical scheme.
He said ‘something as small” as allowing state hospital chief executives to manage such repairs would vastly improve services at government health facilities.
Health industry sources said that there is a great need to collect ‘clinical data” about the management of patients at state hospitals. Brian Ruff, general manager at Discovery Health, said: ‘Such data would tell us how successfully, or unsuccessfully a hospital handles it patients and what could be done differently. At the moment we don’t keep track of a patient’s journey through a hospital. We don’t even know how many patients are transferred between hospital departments.”
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University